After endoscopic treatment of bleeding peptic ulcers, bleeding recurs in 15 to 20 percent of patients. We assessed whether the use of a high dose of a proton-pump inhibitor would reduce the frequency of recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. Patients with actively bleeding ulcers or ulcers with nonbleeding visible vessels were treated with an epinephrine injection followed by thermocoagulation. After hemostasis had been achieved, they were randomly assigned in a double-blind fashion to receive omeprazole (given as a bolus intravenous injection of 80 mg followed by an infusion of 8 mg per hour for 72 hours) or placebo. After the infusion, all patients were given 20 mg of omeprazole orally per day for eight weeks. The primary end point was recurrent bleeding within 30 days after endoscopy. We enrolled 240 patients, 120 in each group. Bleeding recurred within 30 days in 8 patients (6.7 percent) in the omeprazole group, as compared with 27 (22.5 percent) in the placebo group (hazard ratio, 3.9; 95 percent confidence interval, 1.7 to 9.0). Most episodes of recurrent bleeding occurred during the first three days, which made up the infusion period (5 in the omeprazole group and 24 in the placebo group, P<0.001). Three patients in the omeprazole group and nine in the placebo group underwent surgery (P=0.14). Five patients (4.2 percent) in the omeprazole group and 12 (10 percent) in the placebo group died within 30 days after endoscopy (P=0.13). After endoscopic treatment of bleeding peptic ulcers, a high-dose infusion of omeprazole substantially reduces the risk of recurrent bleeding.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Healthcare industry has entered the era of digital health. With the advancement in information technologies and mobile Internet, real-time monitoring and interventions are provided for management of high burden health problems such as cardiovascular diseases (CVDs). The impact of digital health interventions (DHIs) on cost-effective management of CVDs have been examined in literature using the decision analytic model-based health technology assessment (HTA) approach. Objective: The aim of this study was to perform a systematical review on decision analytic model-based studies evaluating the cost-effectiveness of DHIs on the management of CVDs. Methods: A literature research was conducted in Medline, Embase, CINAHL Complete, PsycINFO, Scopus, Web of Science, Center for Review and Dissemination, and Institute for IEEE Xplore, for paper published between 2001 and 2018. Studies were included if the following of criteria were met: (1) English articles, (2) DHIs that promoted clinical practitioners’ intervention and had impact on patients’ cardiovascular conditions, (3) studies that were modelling works with health economic outcomes of DHIs for CVDs, (4) studies that have a comparative group for assessment, and (5) full economic evaluations including cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-consequence analysis. Results: Fifteen studies met the defined criteria and were included in this systematic review. Heart failure and stroke were two frequent CVDs managed with DHIs. DHIs included telemedicine (telephone/mobile phone support, videoconferencing system and telestroke network) and wearable devices. The DHIs gained higher quality-adjusted life-years (QALYs) or improved clinical outcomes when compared with usual care in CVD management in all 15 studies. The DHIs were cost-saving in 5 studies, and incurred additional total cost in 10 studies. The cost-effectiveness of DHIs with higher total cost was subject to the willingness-to-pay threshold. Conclusions: This is the first systematic review of decision model-based cost-effectiveness analyses of DHIs on the management of CVDs. Findings from this review showed that there are few cost-effectiveness analyses of DHIs for CVDs in the literature. The DHIs improved QALYs gain or clinical outcomes of CVDs, and most of the DHIs incurred additional total cost when compared with usual care. Clinical Trial: N.A.

To evaluate the association of VKORC1 genetic variants with warfarin dose requirements in a Hong Kong Chinese patient population. A retrospective study of Hong Kong Chinese patients chronically maintained on warfarin was conducted. Single nucleotide polymorphisms (SNPs) in VKORC1 and CYP2C9 were genotyped. Stable warfarin dose data were retrieved from patient medical records. Sixty-nine patients were included in the analysis. VKORC1 haplotypes H1 (group A) and H7 (group B) were most common, accounting for 86% and 13% of all haplotypic variation in this cohort. Patients carrying at least one copy of a VKORC1 group B haplotype (n=16) required a significantly higher stable warfarin dose (5.17±1.53 mg/day) than patients that were homozygous for group A haplotypes (n=53; 2.93±1.22 mg; P<0.001). In the VKORC1 A/A group, four patients (5.8%) were heterozygous for CYP2C9*3 and had a lower dose requirement (1.94±0.43 mg) than patients that exhibited the CYP2C9 *1/*1 genotype (3.01±1.23 mg), P=0.004. In multivariate analysis, VKORC1 and CYP2C9 explained 31% and 7.9% of the variability in warfarin dose, respectively. VKORC1 genotype is the dominant genetic influence on inter-individual variability in warfarin dose in Hong Kong Chinese. The lower mean dose of warfarin in Chinese, relative to Europeans, appears to be a reflection of their preponderance of the ‘low-dose’ VKORC1 H1/H1 (homozygous group A) genotype.

Aim: To examine the optimal range of International Normalized Ratio (INR) for Chinese patients receiving warfarin for moderate‐intensity anticoagulation.Methods: This was a retrospective cohort study conducted at the ambulatory setting of a 1400‐bed public teaching hospital in Hong Kong. The INR measurements and occurrence of serious or life‐threatening haemorrhagic and thromboembolic events among patients newly started on warfarin from 1 January 1999 to 30 June 2001 for indications with target INR 2–3 were analysed. The INR‐specific incidence of bleeding and thromboembolism were calculated.Results: A total of 491 patients were included, contributing to 453 patient‐years of observation period. Forty‐seven of the 491 patients experienced 25 haemorrhagic events (5.5 per 100 patient‐years) and 27 thromboembolic events (6.0 per 100 patient‐years). The percentage of patient‐time spent within therapeutic INR range (2–3), INR 3 were 50, 44 and 6%, respectively. The incidence of either haemorrhagic or thromboembolic events was lowest (≤4 events per 100 patient‐years) at INR values between 1.8 and 2.4.Conclusions: An INR of 1.8–2.4 appeared to be associated with the lowest incidence rate of major bleeding or thromboembolic events in a cohort of Hong Kong Chinese patients receiving warfarin therapy for moderate‐intensity anticoagulation.

Background: The choices for self-medication in Hong Kong are much diversified, including western and Chinese medicines and food supplements. This study was to examine Hong Kong public knowledge, attitudes and behaviours regarding self-medication, self-care and the role of pharmacists in self-care. Methods: A cross-sectional phone survey was conducted, inviting people aged 18 or older to complete a 37-item questionnaire that was developed based on the Thematic Household surveys in Hong Kong, findings of the health prorfessional focus group discussions on pharmacist-led patient self management and literature. Telephone numbers were randomly selected from residential phone directories. Trained interviewers invited eligible persons to participate using the "last birthday method". Associations of demographic characteristics with knowledge, attitudes and beliefs on self-medication, self-care and role of pharmacists, and spending on over-the-counter (OTC) products were analysed statistically. Results: A total of 1, 560 phone calls were successfully made and 1, 104 respondents completed the survey which indicated a response rate of 70.8%. 63.1% had adequate knowledge on using OTC products. Those who had no formal education/had attended primary education (OR = 3.19, 95%CI 1.78-5.72; p < 0.001), had attended secondary education (OR = 1.50, 95%CI 1.03-2.19; p = 0.035), and aged ≥60 years (OR = 1.82, 95% CI 1.02-3.26; p = 0.042) were more likely to have inadequate knowledge on self-medication. People with chronic disease also tended to spend more than HKD100 on western (OR = 3.58, 95%CI 1.58-8.09; p = 0.002) and Chinese OTC products (OR = 2.94, 95%CI 1.08-7.95; p = 0.034). 94.6% believed that patients with chronic illnesses should self-manage their diseases. 68% agreed that they would consult a pharmacist before using OTC product but only 45% agreed that pharmacists could play a leading role in self-care. Most common reasons against pharmacist consultation on self-medication and self-care were uncertainty over the role of pharmacists and low acceptance level of pharmacists. Conclusions: The majority of respondents supported patients with chronic illness to self-manage their diseases but less than half agreed to use a pharmacist-led approach in self-care. The government should consider developing doctors-pharmacists partnership programs in the community, enhancing the role of pharmacists in primary care and providing education to patients to improve their awareness on the role of pharmacists in self-medication and self-care.